APPLICATION FOR REGISTRATION AS A SUPPLIER OF GENERAL GOODS AND SERVICES ONTO THE SOL PLAATJE MUNICIPALITY SUPPLIERS REGISTER

Transcription

1 Application for registration on the Supplier Register APPLICATION FOR REGISTRATION AS A SUPPLIER OF GENERAL GOODS AND SERVICES ONTO THE SOL PLAATJE MUNICIPALITY SUPPLIERS REGISTER Name of Company: Applicant Name: Contact Person: Contact Person Tel. No: For office use only Received on: DD MM YY Received by (print full name) Signature: Journal Number: Creditor Code: Page 1 of 23

2 Application for registration on the Supplier Register Terms of Reference for Registration onto Sol Plaatje Municipality (SPM) Suppliers Register 1) TERMS OF REFERENCE 1.1) Sol Plaatje Municipality (SPM) Suppliers Registration Policy The SPM has implemented a Supplier Register to ensure that they have sufficient appropriately qualified suppliers to provide the Municipality with goods and services as and when required. 1.2) Supplier(s) Registration onto the Suppliers Register Suppliers that wish to register onto the Suppliers Register should complete the following: The Application Form- Application for Registration as a Supplier of General Goods and Services onto the Suppliers Register) Annexure 1 - (Declaration of bidder s past supply chain management practices SBD 8 &9 ) Annexure 2 - (Commodity Categories) Annexure 3 - (Declaration of Interest- MBD 4) Returnable Documents (Refer to 10.7, pg 13 of Application form) Suppliers must complete a separate application form for each branch if the Company has more than one branch office. NB- Please use a black pen. Please print so that all information is legible. Forms which are not readable or incomplete will be rejected 1.2.1) What does it mean to be registered on the Supplier Register? Suppliers that have been registered onto the Suppliers Register may have the opportunity to bid or quote on the Municipality s acquisition requirements. Registration onto the Suppliers Register does not guarantee business opportunities as all acquisition will be subject to the Supply Chain Management (SCM) policy of SPM ) Registration Period onto the Suppliers Register Registration of suppliers onto the Suppliers Register will be valid for a period of 2 years from date of acceptance onto suppliers register. SPM will issue an instruction on the re-application for the registration process. The Municipality reserves the right to accept or reject any application. 1.3) Maintenance of the Suppliers Register The Sol Plaatje Municipality will update suppliers information on an ongoing basis. Suppliers that have registered onto the Suppliers Register should ensure that they furnish the Municipality with any change to the status of the information initially provided, as and when the information changes. It is the supplier s responsibility to ensure that the information reflected on the Suppliers Register is correct and up to date at all times. Suppliers must ensure that they furnish the Municipality with any updates to or change of information pertaining to banking details as and when the change occurs. 1.4) Supplier Performance Monitoring Suppliers that have registered onto the Suppliers Register will be continuously monitored for their performance on work awarded to them by SPM. This continuous monitoring process will form the basis to evaluate Supplier performance which will have an impact on future work opportunities with the Municipality. 1.5) Confidentiality All information provided by suppliers for registration purposes will remain confidential and will only be of use by SPM unless otherwise required by law. 1.6) Where to obtain Application forms 1.6.1) Availability of Application Forms Application Forms can be downloaded from SPM website ( Application forms can also be collected at Sol Plaatje Municipality. No faxed or ed applications will be accepted. Only original and signed copies of application will be accepted. Suppliers may not alter the Application Form in any way. Page 2 of 23

3 Application for registration on the Supplier Register 1.6.2) Application form submissions The applications forms for registration onto the Suppliers Register will be processed at SPM. Suppliers should therefore ensure that they submit their Application Forms to the address below: Postal Address Supply Chain Management/Demand Management Private Bag X5030 Kimberley 8300 (Note: Post application form by Registered Mail) Hand Delivery Supply Chain Management/Demand Management City Hall No. 2 Market Square Kimberley 8301 Note: Please keep copies of the Application form and all supporting documentation submitted as no copies will be made by the council ) Support at SPM Any queries regarding registration can be directed to: Helpdesk: (053) /5/6/7/90 address: cthage, ttaku, pcimela, avkratenburg@solplaatje.org.za 1.7) Criteria for Registration Suppliers that do not meet the responsive criteria may not qualify to be registered onto the Supplier Register until full registration requirements are met. The Responsive Criteria for suppliers to be registered onto the Supplier Register is stated below: Responsive Criteria for Suppliers for General Goods and Services: Supplier should have a valid Physical Business Address Supplier should have a valid Postal Address Supplier should have a valid Telephone/Cellular Number Supplier should have a valid Fax Number (Optional) Supplier should submit a Business Profile together with the Application Form for Consulting and Professional Services Supplier should provide the Sol Plaatje Municipality with valid Banking details o Personal banking details will not be acceptable except in the case where the supplier is a Sole Trader Supplier should submit an Original valid Tax Clearance Certificate o No Supplier will be registered if such Supplier is not in good standing in so far as his/her tax and service charge obligations (water & electricity accounts) to the municipality are concerned, as per Act 56 of 2003 (MFMA). o All potential suppliers that wish to register on the municipality database must be registered with CIPRO ( 2) IMPORTANT GUIDELINES 2.1) General Ensure that all applicable sections in the Application Form are completed as incomplete Application Forms will not be processed for registration onto the Supplier Register. Verification of information provided by suppliers may be checked against third party sources such as SARS, CIPC (etc) Default Receiver of Contracts: The contact person that will receive notifications from the Sol Plaatje Municipality Default Receiver of Bids: The contact person indicated will receive notification of Bids via or sms (please select the preferred option) Page 3 of 23

4 Application for registration on the Supplier Register 2.2) Important fields to complete 2.2.1) Contact Person Please indicate one (1) individual that the Sol Plaatje Municipality should contact pertaining to Bids and/or Contracts ) Type of Company Please ensure the appropriate documentary proof pertaining to your type of Company is attached and submitted together with the Application Form. Please view below for the required documentary proof: I. Partnership: Certified copy of Partnership Agreement II. Sole Proprietor: Certified copy of valid South African Identity Document III. Public Company registered in terms of the SA Companies Act: Certified copy of Certificate of Incorporation of companies (CM1) IV. Private Company registered in terms of the SA Companies Act: Certified copy of Certificate of Incorporation of companies (CM1) V. Trust: Certified copy of Trust deed or other founding document VI. Other: Please provide appropriate documentary proof 2.2.3) Shareholder/Owner Information Please complete all information for every shareholder/owner listed on the form who has equity ownership in the Company. Please ensure that Total percentage of ownership amount to 100%. Should the space provided in this section not be enough for the required information, please ensure that you make a copy of this section, complete it and submit it together with the Application Form )In terms of Regulation 5 (2) and 6 (2) of the Preferential Procurement Regulations, preference points must be awarded to a bidder for attaining the B-BBEE status level of contribution in accordance with the table below: B-BBEE Status Level of Contributor Number of points (90/10 system) Number of points (80/20 system) Non-compliant contributor 0 0 Page 4 of 23

5 Application for registration on the Supplier Register )Suppliers who qualify as EMEs in terms of the B-BBEE Act must submit a certificate issued by an Accounting Officer as contemplated In the CCA )or a Verification Agency accredited by SANAS or a Registered Auditor. Registered auditors do not need to meet the prerequisite for IRBA s approval for the purpose of conducting verification and issuing EMEs with B-BBEE Status Level Certificates )Suppliers other than EMEs must submit their original and valid B-BBEE status level verification certificate or a certified copy thereof, Substantiating their B-BBEE rating issued by a Registered Auditor approved by IRBA or a Verification Agency accredited by SANAS )A trust, consortium or joint venture, will qualify for points for their B-BBEE status level as a legal entity, provided that the entity submits their B-BBEE status level certificate ) A trust, consortium or joint venture will qualify for points for their B-BBEE status level as an unincorporated entity, provided that the entity submits their consolidated B-BBEE scorecard as if they were a group structure and that such a consolidated B-BBEE scorecard is prepared for every separate bid )Tertiary institutions and public entities will be required to submit their B-BBEE status level certificates in terms of the specialized scorecard contained in the B-BBEE Codes of Good Practice ) A person will not be awarded points for B-BBEE status level if it is indicated in the bid documents that such a bidder intends sub-contracting more than 25% of the value of the contract to any other enterprise that does not qualify for at least the points that such a bidder qualifies for, unless the intended sub- contractor is an EME that has the capability and ability to execute the sub-contract )A person awarded a contract may not sub-contract more than 25% of the value of the contract to any other enterprise that does not have an equal or higher B-BBEE status level than the person concerned, unless the contract is sub-contracted to an EME that has the capability and ability to execute the sub-contract ) BID DECLARATION )Bidders who claim points in respect of B-BBEE Status Level of Contribution must complete the following: )B-BBEE STATUS LEVEL OF CONTRIBUTION CLAIMED IN TERMS OF PARAGRAPHS AND )B-BBEE Status Level of Contribution:. = (maximum of 10 or 20 points) (Points claimed in respect of paragraph 7.1 must be in accordance with the table reflected in paragraph 5.1 and must be substantiated by means of a B-BBEE certificate issued by a Verification Agency accredited by SANAS or a Registered Auditor approved by IRBA or an Accounting Officer as contemplated in the CCA). Ensure that a Medical Certificate is attached and submitted together with the Application Form for all individuals claiming disability. No Preference points will be awarded to public companies and tertiary institutions. Page 5 of 23

6 Application for registration on the Supplier Register 2.2.5) Commodity Categories Suppliers should not tick ( ) items or services which they cannot provide ) Declaration of Interest- MBD 4 Ensure that this document (Annexure 3) is submitted together with the Application Form ) Details of person(s) authorized to act on behalf of the Company This section requires that suppliers provide details pertaining to the individual that the Company authorized to submit and sign the application form on their behalf. Should the Company authorize more than one individual to submit and sign the Application Form on their behalf, please ensure that you make a copy of this section, complete it and submit it together with the Application Form ) Declaration/Commissioner of Oaths This section serves as a confirmation that the information provided is true and correct and must be signed accordingly. Page 6 of 23

7 Application for registration on the Supplier Register 1. COMPANY S BASE DATA: (Compulsory) 1.1 Name of Company: 1.2 Trading As: 1.3 Holding Company Name: 1.4 Company Registration Number: (Insert Companies Act number, etc.) 1.5 TYPE OF COMPANY (Tick applicable box and provide documentary proof): Public Company registered in terms of the SA Companies Act One person business / sole trader Partnership Private Company registered in terms of the SA Companies Act Trust Other: (Specify) 1.6 Telephone Number: 1.7 Fax Number: 1.8 Business Physical Address: Town: 1.9 Postal Address: Postal Code: 1.10 Located in Sol Plaatje Municipal Area? Yes No 1.11 Indicate the Province where the above Company/Branch is located: Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo Mpumalanga North West Northern Cape Western Cape 1.12 Date Company Established: 1.13 VAT Registration Number: 1.14 Company Website Address: BEE Certificate BVA Number: 1.15 BEE Certificate Approved Date: Tax Clearance Certificate Number: 1.16 Tax Certificate Approved Date: Certificate Expiry Date: Certificate Expiry Date: 2. CONTACT PERSON DETAILS: (Complete for at least two Persons Preferably Management) (Compulsory) CONTACT PERSON 1 CONTACT PERSON Contact Name: 2.2 Job Title: 2.3 Receiver of Contracts: Yes No Yes No 2.4 Receiver of Bids: Yes No Yes No 2.5 Telephone Number: 2.6 Fax Number: 2.7 Cellular Number: 2.8 Address: Page 7 of 23

8 (*) Where owners are themselves a Company, Close Corporation, Partnership etc, identify the ownership of the Holding Company, together with registration number (**) State date of South African citizenship obtained (***) Tick Yes or No (Refer to definitions contained in the PPPF Act, 2000 (Act 5 of 2000) and the Preferential Procurement regulations, 2001) 3. REFERENCES (List 5 contracts/projects, which your Company has been engaged in for the last 2 years) Contract Description Location Client Client Telephone Number Contract Amount Completed / Expected Completion Date 4. MAIN SECTOR (Please select only ONE (1)) Agriculture Catering & Accommodation Community, Social and Personal Services Construction Electricity, Gas, Water Finance and Business Services Manufacturing Mining and Quarrying Communications Wholesale Trade, Commercial Agents and Allied Services Retail & Motor Trade & Repair Transport, Storage & Page 8 of 23

9 5. SMME Status of Enterprise (Please tick ( ) relevant box per Sector in each column) Full time paid employees Annual Turnover (millions) Total Gross Asset Value (Excl. Fixed Asset) (millions) Sector Medium Small Very Small Micro Medium Small Very Small Micro Medium Small Very Small Micro Employed Employed Employed Employed R mil R mil R mil R mil R mil R mil R mil R mil Agriculture R5m R3m R0.50m R0.20m R5m R3m R0.50m R0.10m Catering & Accommodation and other Trade R13m R6m R5.10m R0.20m R3m R1m R1.90m R0.10m Community, Social and Personal Services R13m R6m R1m R0.20m R6m R3m R0.60m R0.10m Construction R26m R6m R3m R0.20m R5m R1m R0.50m R0.10m Electricity, Gas, R51m R13m R5.10m R0.20m R19m R5m R1.90m R0.10m Water Finance and Business R26m R13m R3m R0.20m R5m R3m R0.50m R0.10m Services Manufacturing R51m R13m R5m R0.20m R19m R5m R2m R0.10m Mining and Quarrying Retail & Motor Trade & Repair Services R39m R10m R4m R0.20m R23m R6m R2m R0.10m R39m R19m R4m R0.20m R6m R3m R0.60m R0.10m Transport, Storage & Communications R26m R13m R3m R0.20m R6m R3m R0.60m R0.10m Wholesale Trade, Commercial Agents and Allied Services R64m R32m R6m R0.20m R10m R5m R0.60m R0.10m Page 9 of 23

10 6. BANKING DETAILS (A copy of a cancelled cheque must be attached- Compulsory) Name of Account Holder Bank Type of Account Current Account Savings Account Transmission Account Bond Account Other (Please specify) Branch Code Account Number It is hereby confirmed that these details have been verified against the following screens: ABSA- CIF Screen FNB- Hogan s system on the CIS4 STD Bank- Lookup screen Nedbank- Banking platform under the Client Details Tab Other Banks- Client information screen NB: It is the Supplier s responsibility to ensure that the details provided are correct Bank stamp here Bank Official Name: Contact Details: 7. PROVINCES WHERE GOODS / SERVICE CAN BE PROVIDED: (Compulsory - Complete detail in Annexure1 for the Only certain Towns selection.) 8. COMMODITY CATEGORIES: (Compulsory - Select / Specify Commodity Categories and Commodity Sub Categories from Annexure 2) 9. DECLARATION OF INTEREST- MBD 4: (Compulsory - Complete details as per Annexure 3) Page 10 of 23

11 10. DETAILS OF PERSON(S) AUTHORIZED TO ACT ON BEHALF OF THE COMPANY (Mandatory) RESOLUTION OF OWNERS/DIRECTORS/ MEMBERS/PARTNERS RESOLUTION of a meeting of the Board of *Directors / Members / Partners/ Owners of: (Legally correct full name and registration number of the Enterprise, if applicable) Held at On (Place) (Date) RESOLVED that: 1. The Company submits an application to the Sol Plaatje Municipality for registration on SPM's Supplier Register. 2. *Mr/Mrs/Ms: in *his/her Capacity as: Enterprise) (Position in the and who will sign as follows: _(insert specimen signature) be, and is hereby, authorised to sign any documents and/or correspondence in connection with and relating to the Application Form as well as to sign any Contract, and any and all documentation on behalf of the Company. 1 Name Capacity Signature Page 11 of 23

12 Note: 1. * Delete which is not applicable ENTERPRISE STAMP 2. NB. This resolution must be signed by all the Directors / Members / Partners and Owners of the Bidding Enterprise 3. Should the number of Directors / Members/Partners and Owners exceed the space available above, additional names and signatures must be supplied on a separate page 11. DECLARATION: By completing this application form, the Company declares that: 10.1 All the information supplied in this application is true and correct The Company will, without protest submit itself to procedures instituted by the Sol Plaatje Municipality The Company will, if requested to do so supply further information and documentary evidence for scrutiny The Company will update their registration particulars whenever a significant change in their details occurs The Company acknowledges that any false information provided can lead to disqualification from the Supplier Register and being listed on Sol Plaatje Municipality non-preferred supplier list The Company acknowledges that it can be penalized for poor performance as the Municipality deems necessary. Is there any relationship between your organization and any Sol Plaatje Municipality employees? Yes No If yes, please specify nature of relationship and name of person Family Friend Business Partner Full Name: Full Name : Full Name : Page 12 of 23

13 10.7 RETURNABLE DOCUMENTS (Certified copies are acceptable) (Compulsory) General: Yes No N/A Documentary Proof of Company s Registration (Refer to 2.5.4) VAT Registration Certificate Tax Clearance Certificate (Original) PSIRA Certificate (Applicable to suppliers in the Security Industry) Certificate of Acceptability from Municipality (Applicable to suppliers providing Food and Catering Services) Medical Certificate (For Disability Status) Accreditation Certificate (Applicable to suppliers providing computer software and hardware) Business Profile Municipal account/lease Agreement/Affidavit Commodity Categories (Annexure 2) Declaration of Interest- MBD 4 (Annexure 3) Certified copies of Shareholders Identity document CIDB/NHBRC SANAS Accredited BEE certificate/exemption Letter Page 13 of 23

14 Duly authorized to sign on behalf of: (Name of Company) The undersigned who warrants that he / she is duly authorized to do so on behalf of the Company, confirms that the contents of the application are within my personal knowledge and are to the best of my belief both true and correct. Signature Full Name Capacity Date 12. COMMISSIONER OF OATHS: Signed and sworn to before me at (Place) on this the day of by the Deponent, who has acknowledged that he/she knows and understands the contents of this Affidavit, that it is true and correct to the best of his/her knowledge and that he/she has no objection to taking the prescribed oath, and that the prescribed oath will be binding on his/her conscience. Commissioner of Oaths Name: Signature Stamp Note: All pages of this Affidavit must be initiated by both the Deponent and the Commissioner of Oaths. Page 14 of 23

15 Annexure 3 (MBD 4) DECLARATION OF INTEREST 1. No bid will be accepted from persons in the service of the state*. 2. Any person, having a kinship with persons in the service of the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid. In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons connected with or related to persons in the service of the state, it is required that the bidder or his/her authorised representative declare his/her position in relation to the evaluating/adjudicating authority and/or take an oath declaring his/her interest. bid. 3. In order to give effect to the above, the following questionnaire must be completed and submitted with the bid. 3.1 Full name. 3.2 Identity number Company registration number. 3.4 Tax reference number VAT registration number. 3.6 Are you presently in the service of the state* YES / NO If so, furnish particulars. 3.7 Have you been in the service of the state for the past 12 months YES / NO If so, furnish particulars Do you have any relationship (family, friend, other) with persons YES / NO in the service of the state and who may be involved with the evaluation and/or adjudication of this bid? If so, furnish particulars Are you aware of any relationship (family, friend, other) between YES / NO a bidder and any persons in the service of the state and who may be involved with the evaluation and/or adjudication of this bid? If so, furnish particulars.. Page 15 of 23

16 3.10 Are any of the company s directors, managers, principle YES / NO shareholders or stakeholders in service of the state? If so, furnish particulars Are any spouse, child or parent of the company s directors, YES / NO managers, principle shareholders or stakeholders in service of the state? If so, furnish particulars.. * MSCM Regulations in the service of the state means to be - (a) a member of (i) any municipal council; (ii) any provincial legislature; or (iii) the national Assembly or the national Council of provinces; (b) a member of the board of directors of any municipal entity; (c) an official of any municipality or municipal entity; (d) an employee of any national or provincial department, national or provincial public entity or constitutional institution within the meaning of the Public Finance Management Act, 1999 (Act No. 1 of 1999); (e) a member of the accounting authority of any national or provincial public entity; or (f) an employee of Parliament or a provincial legislature. ========================================================================== C E R T I F I C A T I O N I, THE UNDERSIGNED (NAME) CERTIFY THAT THE INFORMATION FURNISHED ON THIS DECLARATION FORM IS CORRECT. I ACCEPT THAT THE STATE MAY ACT AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE. Signature Date Position Name of bidder Page 16 of 23

17 SBD 8 DECLARATION OF BIDDER S PAST SUPPLY CHAIN MANAGEMENT PRACTICES 1 This Municipal Quotation Document must form part of all quotes invited. 2 It serves as a declaration to be used by municipalities and municipal entities in ensuring that when goods and services are being procured, all reasonable steps are taken to combat the abuse of the supply chain management system. 3 Any quote may be rejected if the supplier, or any of it s directors have: - a. abused the municipality s/municipal entity s supply chain management system or committed any improper conduct in relation to such system; b. been convicted for fraud or corruption during the past five years; c. willfully neglected, reneged on or failed to comply with any government, municipal or other public sector contract during the past five years; or d. been listed in the Register for Bid Defaulters in terms of section 29 of the Prevention and Combating of Corrupt Activities Act (No 12 of 2004). 4 In order to give effect to the above, the following questionnaire must be completed and submitted with the quote: - Item Question Yes No 4.1 Is the bidder or any of its directors listed on the National Treasury s database as a company or person prohibited from doing business with the public sector? Yes No (Companies or persons who are listed on this database were informed in writing of this restriction by the National Treasury after the audi alteram partem rule was applied) If so, furnish particulars: 4.2 Is the bidder or any of its directors listed on the Register for Tender Defaulters in terms of section 29 of the Prevention and Combating of Corrupt Activities Act (No 12 of 2004)? access this Register enter the National Treasury s website, click on the icon Register for Tender Defaulters or submit your written request for a hard copy of the Register to facsimile number (012) ) If so, furnish particulars: Yes No 4.3 Was the bidder or any of its directors convicted by a court of law (including a court of law outside the Republic of South Africa) for fraud or corruption during the past five years? If so, furnish particulars: Yes No Page 17 of 23

18 SBD 8 Item Question Yes No 4.4 Does the bidder or any of its directors owe any municipal rates and taxes or municipal charges to the municipality / municipal entity, or to any other municipality / municipal entity, that is in arrears for more than three months? Yes No If so, furnish particulars: 4.5 Was any contract between the bidder and the municipality / municipal entity or any other organ of state terminated during the past five years on account of failure to perform on or comply with the contract? If so, furnish particulars: Yes No CERTIFICATION I, THE UNDERSIGNED (FULL NAME)..... CERTIFY THAT THE INFORMATION FURNISHED ON THIS DECLARATION FORM IS TRUE AND CORRECT. I ACCEPT THAT, IN ADDITION TO CANCELLATION OF A CONTRACT, ACTION MAY BE TAKEN AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.... Signature Date... Position Name of Bidder SBD 9 Page 18 of 23

19 CERTIFICATE OF INDEPENDENT BID DETERMINATION 1 This Standard Bidding Document (SBD) must form part of all bids¹ invited. 2 Section 4 (1) (b) (iii) of the Competition Act No. 89 of 1998, as amended, prohibits an agreement between, or concerted practice by, firms, or a decision by an association of firms, if it is between parties in a horizontal relationship and if it involves collusive bidding (or bid rigging).² Collusive bidding is a pe se prohibition meaning that it cannot be justified under any grounds. 3 Treasury Regulation 16A9 prescribes that accounting officers and accounting authorities must take all reasonable steps to prevent abuse of the supply chain management system and authorizes accounting officers and accounting authorities to: a. disregard the bid of any bidder if that bidder, or any of its directors have abused the institution s supply chain management system and or committed fraud or any other improper conduct in relation to such system. b. cancel a contract awarded to a supplier of goods and services if the supplier committed any corrupt or fraudulent act during the bidding process or the execution of that contract. 4 This SBD serves as a certificate of declaration that would be used by institutions to ensure that, when bids are considered, reasonable steps are taken to prevent any form of bid-rigging. 5 In order to give effect to the above, the attached Certificate of Bid Determination (SBD 9) must be completed and submitted with the bid: ¹ Includes price quotations, advertised competitive bids, limited bids and proposals. ² Bid rigging (or collusive bidding) occurs when businesses, that would otherwise be expected to compete, secretly conspire to raise prices or lower the quality of goods and / or services for purchasers who wish to acquire goods and / or services through a bidding process. Bid rigging is, therefore, an agreement between competitors not to compete. Page 19 of 23

20 SBD 9 CERTIFICATE OF INDEPENDENT BID DETERMINATION I, the undersigned, in submitting the accompanying bid: (Bid Number and Description) in response to the invitation for the bid made by: (Name of Institution) do hereby make the following statements that I certify to be true and complete in every respect: I certify, on behalf of: that: (Name of Bidder) 1. I have read and I understand the contents of this Certificate; 2. I understand that the accompanying bid will be disqualified if this Certificate is found not to be true and complete in every respect; 3. I am authorized by the bidder to sign this Certificate, and to submit the accompanying bid, on behalf of the bidder; 4. Each person whose signature appears on the accompanying bid has been authorized by the bidder to determine the terms of, and to sign the bid, on behalf of the bidder; 5. For the purposes of this Certificate and the accompanying bid, I understand that the word competitor shall include any individual or organization, other than the bidder, whether or not affiliated with the bidder, who: (a) (b) (c) has been requested to submit a bid in response to this bid invitation; could potentially submit a bid in response to this bid invitation, based on their qualifications, abilities or experience; and provides the same goods and services as the bidder and/or is in the same line of business as the bidder SBD 9 6. The bidder has arrived at the accompanying bid independently from, and without consultation, communication, agreement or arrangement with any competitor. However communication between partners in a joint venture or consortium³ will not be construed as collusive bidding. Page 20 of 23

21 7. In particular, without limiting the generality of paragraphs 6 above, there has been no consultation, communication, agreement or arrangement with any competitor regarding: (a) prices; (b) geographical area where product or service will be rendered (market allocation) (c) methods, factors or formulas used to calculate prices; (d) the intention or decision to submit or not to submit, a bid; (e) the submission of a bid which does not meet the specifications and conditions of the bid; or (f) bidding with the intention not to win the bid. 8. In addition, there have been no consultations, communications, agreements or arrangements with any competitor regarding the quality, quantity, specifications and conditions or delivery particulars of the products or services to which this bid invitation relates. 9. The terms of the accompanying bid have not been, and will not be, disclosed by the bidder, directly or indirectly, to any competitor, prior to the date and time of the official bid opening or of the awarding of the contract. ³ Joint venture or Consortium means an association of persons for the purpose of combining their expertise, property, capital, efforts, skill and knowledge in an activity for the execution of a contract. Page 21 of 23

22 SBD I am aware that, in addition and without prejudice to any other remedy provided to combat any restrictive practices related to bids and contracts, bids that are suspicious will be reported to the Competition Commission for investigation and possible imposition of administrative penalties in terms of section 59 of the Competition Act No 89 of 1998 and or may be reported to the National Prosecuting Authority (NPA) for criminal investigation and or may be restricted from conducting business with the public sector for a period not exceeding ten (10) years in terms of the Prevention and Combating of Corrupt Activities Act No 12 of 2004 or any other applicable legislation. Signature Date. Position Name of Bidder Page 22 of 23

23 Sol Plaatje Municipality SOL PLAATJE MUNICIPALITY, KIMBERLEY LISTING CRITERIA 1) Company Name: 2) Contact Details: Tel No:... Fax No:.... Cell phone No:.. 3) Postal Address: ) VAT Registered: Yes No If registered, VAT Registration No:.. 5) Settlement Discount Allowed:... % for payment within...days 6) Bank Name:. 7) Account No: Type of Account:... Branch code:... 8) Location in Sol Plaatje Municipal Area: Yes No 9) % owned by black male:...% % owned by black female:..% % owned by black youth:.. % % owned by white female:.% % owned by disabled persons..% 10) B-BBEE Status Level of Contribution:... 11) Indicate Main Sector/ Please select one only: Agriculture ; Mining and Quarrying ; Manufacturing ; Electricity, Gas, Water ; Construction ; Retail & Motor Trade & Repairs ; Wholesale Trade, Commercial Agents and Allied Services ; Catering & Accommodation & other Trade ; Transport, Storage & Communications ; Finance and Business Services ; Community, Social and Personal Services 12) Amount of full time employed staff:... Annual Turnover: R.... Asset Value (excluding fixed property): R.. Page 23 of 23